Pacer Staffing LLC

Clinical - Program Specialist (Social Worker) 1

Pacer Staffing LLC United States
Pacer Staffing LLC

Clinical - Program Specialist (Social Worker) 1

Pacer Staffing LLC United States
4 weeks ago
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Job Description

Job Title: Program Specialist 1- Social Worker

Location: Remote (Mcallen Texas, 78501 Possibility to train from office for first 1-2 weeks)

Duration: 6 months (Possible extension)

Shift: Mon-Fri 8 am- 5 pm

Job Summary

  • Conduct screening and risk assessment interventions per program guidelines.
  • Assist with non-medical aspects of the member’s care, including referrals to community resources.

Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):

  • Telehealth assessments
  • Review assessments & service plans (vendor or internal assessments)
  • Follow up on pending assessment findings, clarify DX, reported abnormals, requested referrals, etc.
  • Hospital discharges follow up
  • MN denials
    • Research community resources.
  • 2065D approval/denials
    • Update LTSS
    • Terminate LTSS waiver service authorizations.
    • Provide community resources.
    • Instruct member on appeal process and level change.
  • ISP updates (internal), 1700-3 obtain verbal approval and update form, update 1700-2 with waiver items.
  • Initiate LTSS/acute services (create authorization request template)
  • Research complaints and provide updates to managers for complaint responses.
  • Escalations
    • MSC call backs.
  • CDS review
  • Acute UM denials to include PT denial, request for more information.
  • Create clinical reviews/IRTs
  • CIC, CIS without MNLOC completion.
  • Fair hearing assistance as needed.
  • Determine MN for post assessment identified items.
  • Dental, nursing, vision, verify service utilization, hearing, 90 day MHM, 28 day follow ups.
    • Verify all services have been started.
    • Follow up on all non DME identified needs.
  • Send required referrals for new services/items identified except DME.
  • Submit DME tasks for newly identified DME items.
Describe the performance expectations/metrics for this individual and their team:

  • Review monthly audits and weekly calls to ensure we are meeting contractual requirements

Job Responsibilities

  • Healthy Opportunities (HOP) Eligibility & Enrollments, Benefits Eligibility Screenings, Cold Calls, Assistance in phone queue.
  • Identify special needs members through the completion of health screens and other resources.
  • Work with community outreach/member advocates to coordinate member care.
  • Educate providers and community resources on program components and available support services.
  • Educate members with special needs to foster compliance with program and positively impact outcomes.
  • Conduct site visits as appropriate for programs and provide support to other special programs.
  • Develop and modify care plans in conjunction with members, member’s family and managing physician.
  • Development of plan specific literature and education materials in conjunction with medical director and corporate oversight

Minimum Qualification

  • Bachelor/master’s in social work.
  • Proficient with excel/word.
  • Experienced MSW/SW in a healthcare/community setting.
  • Community work, experience with closing SDoH needs.

  • Seniority level

    Associate

  • Employment type

    Contract

  • Job function

    Health Care Provider

  • Industries

    Staffing and Recruiting

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